Journal Article

The Impact of Cirrhosis on CD4<sup>+</sup> T Cell Counts in HIV-Seronegative Patients

Barbara H. McGovern, Yoav Golan, Marvin Lopez, Daniel Pratt, Angela Lawton, Grayson Moore, Mark Epstein and Tamsin A. Knox

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 44, issue 3, pages 431-437
Published in print February 2007 | ISSN: 1058-4838
Published online February 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/509580
The Impact of Cirrhosis on CD4+ T Cell Counts in HIV-Seronegative Patients

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Background.Studies of the progression liver fibrosis in human immunodeficiency virus (HIV) and hepatitis C virus-coinfected patients suggest that cirrhosis is associated with immunosuppression, as measured by low absolute CD4+ T cell counts. However, we hypothesized that, in patients with advanced liver disease, low CD4+ T cell counts may occur secondary to portal hypertension and splenic sequestration, regardless of the presence or absence of HIV infection.

Methods.Sixty HIV-seronegative outpatients with cirrhosis were enrolled during the period 2001–2003 in a prospective, cross-sectional study of the association between liver disease and CD4+ T cell counts and percentages. Demographic characteristics, liver disease-related characteristics, and laboratory results—including CD4+ T cell parameters—were collected.

Results.A total of 39 patients (65%) had a low CD4+ T cell count; 26 patients (43%) and 4 patients (7%) had CD4+ T cell counts <350 and <200 cells/mm3, respectively. Abnormal CD4+ T cell counts were associated with splenomegaly (P = .03), thrombocytopenia (P = .002), and leukopenia (P < .001). The percentage of CD4+ T cells was normal in 95% of patients who had a low absolute CD4+ T cell count. CD4+ T cell counts were significantly lower among cirrhotic patients than among 7638 HIV-seronegative historic control subjects without liver disease.

Conclusions.Cirrhosis is associated with low CD4+ T cell counts in the absence of HIV infection. Discordance between low absolute CD4+ T cell counts and normal CD4+ T cell percentages may be attributable to portal hypertension and splenic sequestration. Our findings have significant implications for the use and interpretation of absolute CD4+ T cell counts in HIV-infected patients with advanced liver disease.

Journal Article.  3723 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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